aiqbench analysis
This study reveals that standard automated metrics like SSIM and PSNR often fail to align with expert clinical judgment when evaluating chest X-ray models. The research demonstrates that shifting evaluation references can drastically alter performance estimates and model rankings for various architectures, including ResNet and vision-language models. Consequently, the choice of validation benchmarks is not merely a technical detail but a critical determinant of which AI systems are deemed viable for deployment in real-world clinical settings.
Rethinking Clinical Relevance in Chest X-ray Machine Learning: How Evaluation References Define Performance
arXiv:2607.26333v1 Announce Type: cross Abstract: Chest X-ray (CXR) machine learning relies heavily on automated evaluation using reference standards that aim to approximate clinical judgment. However, commonly used report-derived labels for pathology classification or generic image quality metrics for reconstruction may not reliably reflect clinical judgment. We systematically investigate how evaluation-reference choices affect model performance and ranking in both pathology classification and image quality assessment (IQA). To enable controlled comparison across evaluation references, we collected paired expert image- and report-derived labels for thoracic findings from a clinical cohort at Cambridge University Hospitals (CUH) and curated a subset of the public MIMIC-CXR dataset, along with expert ratings of diagnostic image quality. We show that for supervised image classifiers (ResNet, DenseNet), several zero-shot and fine-tuned vision-language models (e.g., MedKLIP, GLoRIA, and ConVIRT), changing the label source leads to substantial differences not only in performance estimates but also in model rankings. In parallel, alignment of IQA measures with expert judgment depends heavily on the choice of measure, and commonly used IQA metrics such as SSIM and PSNR often fail to align with expert assessments of diagnostic usability. Our results demonstrate that evaluation choices are crucial: they can determine which models and methods appear best and are therefore selected for further development or deployment. The selection of evaluation references should therefore be treated as a central component of clinical validity in CXR machine learning, and justified with respect to the pathology, imaging task, and intended downstream clinical use.
Authors:Panagiotis Fytas, Ian Selby, Clemens Karner, Judith Babar, Simon Baker, Jake Beckford, Timothy J. Sadler, Shahab Shahipasand, Arthikkaa Thavakumar, John Li Chen, Alex Sawer, Michael Roberts, Jonathan Weir-McCall, J. H. F. Rudd, Carola-Bibiane Schönlieb, Anna Korhonen, Anna Breger
Abstract:Chest X-ray (CXR) machine learning relies heavily on automated evaluation using reference standards that aim to approximate clinical judgment. However, commonly used report-derived labels for pathology classification or generic image quality metrics for reconstruction may not reliably reflect clinical judgment. We systematically investigate how evaluation-reference choices affect model performance and ranking in both pathology classification and image quality assessment (IQA). To enable controlled comparison across evaluation references, we collected paired expert image- and report-derived labels for thoracic findings from a clinical cohort at Cambridge University Hospitals (CUH) and curated a subset of the public MIMIC-CXR dataset, along with expert ratings of diagnostic image quality. We show that for supervised image classifiers (ResNet, DenseNet), several zero-shot and fine-tuned vision-language models (e.g., MedKLIP, GLoRIA, and ConVIRT), changing the label source leads to substantial differences not only in performance estimates but also in model rankings. In parallel, alignment of IQA measures with expert judgment depends heavily on the choice of measure, and commonly used IQA metrics such as SSIM and PSNR often fail to align with expert assessments of diagnostic usability. Our results demonstrate that evaluation choices are crucial: they can determine which models and methods appear best and are therefore selected for further development or deployment. The selection of evaluation references should therefore be treated as a central component of clinical validity in CXR machine learning, and justified with respect to the pathology, imaging task, and intended downstream clinical use.
Image and Video Processing (eess.IV); Computer Vision and Pattern Recognition (cs.CV); Machine Learning (cs.LG)
arXiv:2607.26333 [eess.IV]
(or arXiv:2607.26333v1 [eess.IV] for this version)
https://doi.org/10.48550/arXiv.2607.26333 arXiv-issued DOI via DataCite (pending registration)
Full text under the publisher's open licence · 305 words
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